Zhang Shubao, Geng Fengyang, Wang Jiyue, Zhang Zhiti, Du Chigang
Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China.
Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China.
World Neurosurg. 2018 Jul;115:216-219. doi: 10.1016/j.wneu.2018.04.145. Epub 2018 Apr 27.
Spontaneous spinal epidural hematoma (SSEH) is a relatively uncommon yet potentially disabling neurologic emergency. The classical presentation includes a severe acute attack, sometimes radiating pain at the back, interscapular, or neck areas, followed by neurologic deficits. The main treatment is surgical, and self-healing cases are rare.
A 17-year-old female was admitted to the neurosurgery department with neck pain, myasthenia of the limbs, and difficulty moving. Mild neck pain had developed 1 week prior with no obvious predisposing causes. The patient had suddenly suffered severe neck pain during normal walking and developed rapid paralysis of her limbs. There was no recent history of trauma, infection, or drug administration. Magnetic resonance imaging performed 1 hour after the onset of limb paralysis demonstrated a large spinal epidural hematoma that extended from C4 to C6. However, 9 hours after the initial onset of severe neck pain, her symptoms completely ceased. Magnetic resonance imaging demonstrated that the SSEH had nearly dissipated.
Most cases of SSEH with spontaneous resolution are located on the upper thoracic and cervical spine. Surgery is the standard of care for these patients but can occasionally be deferred if the patient demonstrates significant rapid improvement.
自发性脊髓硬膜外血肿（SSEH）是一种相对罕见但可能导致残疾的神经系统急症。典型表现包括严重的急性发作，有时伴有背部、肩胛间或颈部区域的放射性疼痛，随后出现神经功能缺损。主要治疗方法是手术，自愈病例罕见。
一名17岁女性因颈部疼痛、肢体肌无力和活动困难入住神经外科。1周前出现轻度颈部疼痛，无明显诱因。患者在正常行走时突然出现严重颈部疼痛，并迅速出现肢体瘫痪。近期无外伤、感染或用药史。肢体瘫痪发作1小时后进行的磁共振成像显示一个从C4延伸至C6的巨大脊髓硬膜外血肿。然而，在严重颈部疼痛最初发作9小时后，她的症状完全消失。磁共振成像显示SSEH几乎消散。
大多数自发消退的SSEH病例位于上胸椎和颈椎。手术是这些患者的标准治疗方法，但如果患者症状迅速明显改善，偶尔可以推迟手术。
